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Cotswold Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 13 October 2016

We carried out an announced comprehensive inspection at Cotswold Medical Practice on 2 September 2016. Overall the practice is rated as good, and outstanding for providing responsive services.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence-based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 97% of patients said they could get through easily to the practice by phone compared with the clinical commissioning group (CCG) average of 83% and the national average of 73%.
  • The patient participation group (PPG) were well engaged and represented across all age groups, and across a diverse range of professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon. Also the group had raised awareness about patient services. The practice is participating in a social prescribing scheme to support people who attend their GP surgery but do not necessarily require medical care. Social prescribing supports people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that can help improve their wellbeing and meet their wider needs.
  • Staff had lead roles that improved outcomes for patients such as a care co-ordinator and a carer’s champion.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We saw three areas of outstanding practice:

  • The practice funds and hosts a memory clinic. Following in-house assessments, patients may be referred to clinicians who specialise in memory problems, such as psychologists, geriatricians or dementia specialist nurses. The clinic has been running for four years, with a total of 67 patients referred in the past 12 months.
  • The practice rents a room in a local organisation for art therapy sessions. The service is funded by charitable donations raised by the practice and available on referral, for patients who have suffered bereavement, were carers, or were experiencing mental health issues. An average of 25 practice patients per week attend classes and a total of 33 patients have attended classes this year.
  • The practice hosts a skin camouflage service for patients who would like to camouflage scarring or a skin condition such as vitiligo. The service is provided by a charity, which is supported by donations from the practice, and is available on referral. The practice has referred 15 of its patients in the past four years, and hosts this service for the county and wider area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice.

Inspection areas

Safe

Good

Updated 13 October 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 13 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework for April 2015 to March 2016 showed patient outcomes were at or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • We saw a programme of clinical audits that included improvements for patient care, with completed second cycle audits.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 13 October 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey (January 2016) showed patients rated the practice as either comparable with or better than other local practices for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had identified patients who acted as carers and alerted them whenever a local carers group met. This provided an opportunity for carers to gain support and raised awareness of carers services locally.
  • The practice rents a room in a local organisation for art therapy sessions. The service is funded by charitable donations raised by the practice and available on referral, for patients who have suffered bereavement, were carers, or were experiencing mental health issues.

Responsive

Outstanding

Updated 13 October 2016

The practice is rated as outstanding for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and clinical commissioning group (CCG) to secure improvements to services where these were identified. For example, the practice is participating in a social prescribing scheme to support people who attend their GP surgery but do not necessarily require medical care. Social prescribing supports people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that can help improve their well-being and meet their wider needs.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with regular appointments available the same day.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of patient feedback.
  • The practice had good facilities and was well-equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice increased the length of individual appointment times for patients with complex medical conditions, from 20 to 30 minutes.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
  • The practice offered a range of services to avoid unplanned hospital admissions for elderly patients, such as in-house collection of blood samples and ambulatory blood pressure monitoring.
  • Patients were referred to a nurse from a local mental health trust who is based at the practice for one day a week.
  • The practice hosted a range of services such as retinal screening, and hearing aid and chiropody clinics, and provided a memory clinic.
  • The practice offered text reminders for appointments.
  • The practice provides a room for mothers to breastfeed their children.
  • The practice offered health advice and support for clinically obese patients followed by referral to a reputable weight loss organisation.
  • The practice offered extended opening hours on Monday and Wednesday.
  • Selected patients were offered the use of technology in their homes, to self-manage long term conditions such as diabetes, heart disease and Chronic Obstructive Pulmonary Disease (COPD).
  • The practice recruited patients for a volunteer car service due to poor transport links.
  • The practice hosted a citizens advice surgery. The surgery offered patients support with financial, legal and other civil matters.
  • The practice hosted a skin camouflage service for patients who would like to camouflage scarring or a skin condition such as vitiligo.
  • The practice referred patients to local community health improvement schemes such as:

    • ‘Active and Able’, designed for older people who have a fear or history of falling, balance problems, and low bone density;
    • ‘Men in Sheds’, which uses woodwork and other activities to support older men and combat social isolation and learn new skills;
    • Memory Clubs, designed to support people who are concerned about their loss of memory.
    • ‘Active Lifestyles’, a scheme run by Gloucestershire Council in partnership with local GP practices. The scheme helps people with medical conditions such as diabetes and coronary heart disease (who are not normally active) to access a supported 12-week exercise programme.

Well-led

Good

Updated 13 October 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The provider encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 13 October 2016

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for patients with long-term conditions compared with national averages. For example, 73% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice increased the length of individual appointment times for patients with complex medical conditions from 20 to 30 minutes.
  • The practice offered patients the use of technology in their homes, to self-manage long term health conditions.

Families, children and young people

Good

Updated 13 October 2016

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. The practice assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 81%, consistent with the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • The practice hosted a midwifery clinic on one morning per week, and post-natal midwifery home visits.
  • The practice provided a room for mothers to breastfeed their children.

Older people

Good

Updated 13 October 2016

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice offered a range of services to avoid unplanned hospital admissions for elderly patients, such as in-house collection of blood samples and complex leg ulcer management.
  • The practice referred patients to local community health improvement schemes.
  • Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.
  • The practice hosted a range of services such as retinal screening, and hearing aid and chiropody clinics, and provided a memory clinic.

Working age people (including those recently retired and students)

Good

Updated 13 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • Patients were able to order repeat prescriptions on-line.
  • The practice offered text reminders for appointments.
  • Patients were able to book and attend appointments throughout the day.
  • Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
  • The practice offered extended opening hours on Monday and Wednesday.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • 74% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was below the clinical commissioning group (CCG) average of 86% and the national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose level of alcohol consumption had been recorded over the course of a year was 94%, which was better than the national average of 90%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • Patients were referred to a nurse from a local mental health trust who is based at the practice for one day a week.

People whose circumstances may make them vulnerable

Good

Updated 13 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
  • The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were visited by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.
  • The practice hosted a skin camouflage service for patients who would like to camouflage scarring or a skin condition such as vitiligo.